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PICO Reimbursement Hotline:

Coverage:

Important reminders:

Suggestions when using single use negative pressure wound therapy “sNPWT” eg PICO sNPWT:

  1. Verify that sNPWT codes 97607 and 97608 are listed on your Charge Description Master (CDM)
  2. Verify the HOPD charges for sNPWT codes 97607 and 97608 include the combined charges for the PICO device and for the work to assess the wound, to apply the PICO device, and to provide instructions for ongoing use
  3. Verify that the charges for 97607 and 97608 are different than the charges for 97605 and 97606 (which should not include a charge for the NPWT durable medical equipment)

CAUTION:

Many HOPD Charge Description Masters mistakenly cross-walk the same charges from 97605/97606 to 97607/97608. This fails to capture the cost of the PICO device in the HOPD charges for 97607 and 97608. Understanding the importance of updating your CDM for sNPWT to ensure charges reflect the fact that sNPWT always includes the purchase of the device, while Traditional Negative Wound Therapy (tNPWT) does not.

Smith & Nephew, Inc. provides this content for informational purposes only. The information contained herein is gathered from various sources on November 2018 and is subject to change without notice. Smith & Nephew, Inc. cannot guarantee success in obtaining coverage or payment. Reimbursement for medical products and services is affected by numerous factors. It is always the provider’s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered. Actual codes and/or modifiers used are at the sole discretion of the treating physician and/or facility. Providers should contact their third-party payers for specific information on their coding, coverage, and payment policies. This guide is in no way intended to promote the off label use of any product.